If you wait till you’re sick to sign up for Obamacare, you may pay a bundle

Among the more insidious features baked into the Affordable Care Act — and one that has received relatively little attention — is a built-in deterrent to those who might try to game the system by waiting until they get sick to apply for health insurance. The thinking goes like this: Since the law prohibits insurers from denying or delaying coverage of pre-existing conditions, why not just pay the penalty, which is much less expensive, until you need for health care services? (There are actually ways of avoiding paying the penalty as well, more on which can be found here.)

As for playing the waiting game, the law is structured in a way that requires gamers to gamble with their health or at least their pocketbooks. Writing at Business Insider, Josh Barro observes that “signup for insurance exchanges will be limited to a specific annual enrollment period.” It is already a well-known fact that the first enrollment period ends March 31 of 2014. No one talks much about what happens after that.

What happens is this: The health care turns back into a pumpkin for the six and a half months between the end of March and Oct. 15, 2014, when the next enrollment period begins. In the interim, no new policies will be written through the state or federal exchanges. If you become ill or are in an accident and need medical treatment, you will still be able to buy health insurance, but only through a private carrier. The premium, which will be adjusted to reflect the “essential services” dictated by the law, is likely to be astronomical. Witness the sticker shock encountered at present by Americans with individual policies who are receiving cancelation notices.

It gets even worse. In subsequent years, the window on enrollment is a three-week period, from Oct. 15 to Dec. 7. That means your opportunity to buy health care through a government exchange and possibly qualify for a subsidy exists for 3 out of every 52 weeks. So much for the promise of accessible coverage.

Thus, as Barro writes:

[W]hile going without insurance will be less risky under Obamacare than it is today … it still entails a major risk.

It is worth noting the law still makes exception for what it calls “Qualifying Life Events.” These include life-altering situations such as moving to a new state, changes to income, and changes in family size (for example, if you marry, divorce, or have a baby). Sham marriage, anyone?

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